Thrombopoietin of the liver is like Erythropoietin of the kidney.

✅ Failure of kidney ➡️ Anemia.

✅ Failure of liver ➡️ Thrombocytopenia.

However,

"Despite thrombocytopenia in liver disease, there is an increased risk of thrombosis".

Why there is increased risk of THROMBOSIS in liver disease despite having thrombocytopenia?

⬇️

1. Reduced synthesis of anticoagulant proteins, such as protein C, protein S, and antithrombin, by the damaged liver cells.

2. Increased levels of factor VIII, a procoagulant protein, due to reduced clearance by the dysfunctional liver and increased production by the inflamed endothelium.

3. Activation of the coagulation cascade by endotoxins, cytokines, and tissue factor released from the injured liver or bacterial translocation.

4. Impaired fibrinolysis due to increased levels of plasminogen activator inhibitor-1 (PAI-1) and decreased levels of tissue plasminogen activator (tPA).

5. Reduced blood flow and increased viscosity in the portal vein due to porta hypertension, splenomegaly, and hypersplenism.

⬇️

How chronic kidney disease (CKD) increases the risk of thrombosis ?

1. Altered Clotting Factors: CKD disrupts the balance of clotting and anti-clotting factors in the blood, favoring a pro-thrombotic environment.

2. Endothelial Dysfunction: Impaired kidney function can lead to dysfunction of the blood vessel lining (endothelium), promoting clot formation.

3. Inflammation and Immunity: CKD can disturb the balance of inflammatory and immune responses, contributing to an increased tendency for clotting.

4. Platelet Abnormalities: CKD can cause abnormalities in platelet function, making them more likely to form clots.

5. Reduced Blood Flow: Kidney dysfunction may reduce blood flow, leading to stagnation and clot formation in blood vessels.

6. Metabolic Imbalances: CKD-related metabolic changes can promote a pro-thrombotic state, increasing the risk of clotting.

7. Anticoagulant Deficiency: CKD may reduce levels of natural anticoagulants in the blood, further enhancing clotting potential.

8. Vascular Calcification: CKD-related mineral imbalances can lead to vascular calcification, which contributes to clot formation.

CKD also increases the risk of thrombosis.

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